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Toddler is Hospital's First to Use Berlin Heart Without Requiring Transplant

Wednesday, April 24, 2013

A 16-month-old heart patient at St. Louis Children’s Hospital who recently returned home to Louisville, Kentucky, has left a significant historical imprint on the hospital’s cardiology team.

Keyoney Jenkins will be remembered not for what happened while on the Berlin heart in the Cardiac Intensive Care Unit, but for what didn’t happen.

“She is the first St. Louis Children’s Hospital patient placed on a formal wean plan for the Berlin heart because of the improvement to her heart function,” says Dr. Kathleen Simpson, Keyoney’s cardiologist. In other words, Keyoney didn’t need a heart transplant.

Keyoney arrived on ECMO to St. Louis Children’s in early January from Kosair Children’s Hospital in Louisville. The previously healthy toddler had developed myocarditis and was in heart failure. “The intensive care team and cardiologists at Kosair Children’s felt Keyoney needed to be at a center where she could get a ventricular assist device (VAD) or potentially be transplanted,” says Dr. Celeste Capers, Washington University pediatric intensivist and medical director of the hospital’s transport team.

Keyoney became only the third patient to be transported to St. Louis Children’s Hospital while on ECMO. Children’s had recently launched an ECMO transport program, making it one of few pediatric hospitals in the country equipped to transport a child on ECMO.

“Prior to ECMO transport, Keyoney’s only option would have been to remain on ECMO until her heart recovered,” explains Dr. Capers. “Every day ECMO accrues risk of major bleeding, infection and stroke.”

The St. Louis Children’s and Washington University Heart Center team placed Keyoney on the Berlin heart, with the expectation it would bridge her to a heart transplant, as the Berlin had done for dozens of children before Keyoney.

In this case, Dr. Simpson and her team recognized an opportunity. “She was growing and thriving on the Berlin heart,” says Simpson. “An echocardiogram performed at the end of February revealed improvement... Given these echo findings we decided to start Keyoney on maximal oral heart failure medications and discuss the possibility of weaning her.”

It was new territory for the nationally-ranked heart failure program at St. Louis Children’s.

“There are very few national cases where pediatric patients have been able to be weaned off of the Berlin heart.”

St. Louis Children’s was also one of the first pediatric hospitals to use the Berlin heart, and participated in the FDA trial which ultimately led to wide-spread approval of the device at transplant centers across the U.S.

“Keyoney’s case is significant,” says Dr. Simpson, “because it’s given our team an opportunity to recognize unique circumstances where weaning from the Berlin is a safe and appropriate alternative to a heart transplant.”